The Management of Persistent Diarrhoea and Malnutrition:

Summary of Meeting Presentation

Peter Sullivan from the Department of Paediatrics,
University of Oxford presented a paper on 'the Management of Persistent
Diarrhoea and Malnutrition (PDM) at the International Child Health Group
Meeting on Managing Childhood Malnutrition: in Birmingham.

Dr Sullivan explained, how a pressing concern
amongst paediatricians is the continuing high mortality rates in children
with PDM (between 3-20% of diarrhoea becomes persistent). This, he attributed
to faulty case-management. For example, inappropriate diets that do not
take account of metabolic adaptations to malnutrition are commonplace and
may account for many deaths. Another crucial aspect is inadequate treatment
of microbial infections which significantly affect the outcome of nutritional
rehabilitation in children with PD. Studies have shown that following treatment
and cure for PDM many children relapse, and that even after one year the
state of the gut is similar to when the child first presented.

It was explained how successful nutritional
rehabilitation of children with persistent diarrhoea (PD) requires an understanding
of the biology of malnutrition and of guidelines for provision of appropriate
diets. MN is an important factor in determining the duration of PD
and in the success of treatment. In order to treat PD and MN effectively
one needs to have a good understanding of:

i) the severity of the MN and its impact
on immunity and body organs

ii) the importance of the effects of microbial
infection

iii) the central role of prolonged damage
to the gut and its effect on recovery

An understanding of the complex interactions
that take place at the surface of the small intestine (luminal-mucosal
interface) is central to understanding the nature of PD. Once PD has developed,
then nutritional management is the mainstay of treatment and should lead
to normal growth in the long term. Therapy involves a three -stage process
of addressing acute problems, restoring nutrient balance and ensuring complete
nutritional rehabilitation.

In looking to the future, Dr Sullivan stated
that establishing the best rehabilitation diet for children with PD is
currently a challenge facing many researchers around the world. Questions
are being asked about what are the best diets to give the gut a better
chance of recovery. For example, certain foods may have an advantageous
effect on gut permeability, so that nutrients can be absorbed into the
body during PD, while other foods may inhibit microbial attachment to the
gut.

An abstract of this presentation can
be obtained from Peter Sullivan at the Department of Paediatrics, University
of Oxford